Poor performance on the Westmead PTA Scale could be due
to a number of other factors apart from post-traumatic amnesia.
These include: poor motivation; malingering; medication effects;
a further episode of head trauma, perhaps the patient fell out
of bed; an undetected episode of hypoxia, for example when the
patient needed emergency resuscitation; failure to diagnose any
premorbid difficulties or problems, like a previous learning disorder;
or an undetected communication disorder like dysphasia or dyspraxia.
These must be ruled out in order to convincingly demonstrate that
the patient is still in PTA.
This is where close observation and accurate record keeping on
the part of the PTA examiner is vital, as the information collected
can be used to see if a pattern emerges from the patient's test
behaviour. For instance: the patient may have a problem with a
particular part of the scale (like the picture cards); or they
may consistently require the use of a particular test procedure
(like the choice of 3 options for Question 5). This test behaviour
can then be analysed with regard to other evidence or behaviour
observed by staff. Discuss this information with the Clinical
Neuropsychologist who will then make an entry in the medical record
if they believe a patient's performance on the scale is being
adversely affected.
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